The clinical manifestations of Cushing's syndrome can be quite variable and are frequently mistaken, with consequent delayed diagnosis and significant morbidity and mortality. Harvey Cushing described the typical signs and symptoms of Cushing's syndrome but unfortunately attributed the features to myxoedema. The first typical description of a patient with Cushing's syndrome was probably made by Sir William Osler in 1898. Thus delay or misdiagnosis with consequent high morbidity and mortality exemplifies the history of Cushing's syndrome. Four cases of Cushing's syndrome are described that were associated with deteriorating morbidity because of the considerable delay from first presentation to a secondary care physician to eventual diagnosis. The clinical diagnosis was delayed in all the four patients, although they had symptoms and signs that were missed by a number of primary and secondary care physicians. Trans-sphenoidal surgery resulted in biochemical cure as well as improvement in the accompanying co-morbidity. Although still rare, the prevalence of Cushing's syndrome is increasing. Increasing clinical awareness and the use of appropriate screening tests should facilitate earlier diagnosis with reduced morbidity and mortality. Although the syndrome is named after Harvey Cushing, Sir William Osler was probably the first to describe it. Therefore, in deference to Osler's contribution to Cushing's syndrome and the work of Harvey Cushing, it is suggested that to the list of the other eponymous conditions of Osler-Weber-Rendu and Osler's nodes, should be added the delay or misdiagnosis of Cushing's syndrome-"Osler's phenomenon". (+info)
A case of congenital pulmonary vein stenosis in an adult.
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A 35-year-old Japanese woman, complaining of dyspnea after her first delivery, was diagnosed as having primary pulmonary hypertension. Continuous intravenous prostacyclin resulted in an improvement in her cardiac function, 6-min walk and New York Heart Association class, before she died of pulmonary hypertension crisis during further evaluation for pulmonary transplantation. Since the autopsy findings revealed that all 4 pulmonary veins were extremely stenotic due to hypoplasia, she was diagnosed as having had congenital pulmonary vein hypoplasia with stenosis. (+info)
Kikuchi's disease.
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An 11-year-old girl presented with high grade, intermittent fever and cervical lymphadenopathy. She had multiple enlarged left cervical lymph nodes. The examination of other systems was normal. Workup for sepsis, malignancy and autoimmune disease were negative. VA-IgM for EBV was positive and histopathology of the lymph node was consistent with Kikuchi's disease. (+info)
Unilateral ovarian abscess caused by Salmonella.
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BACKGROUND: Patients with unilateral ovarian abscesses due to Salmonella are rare. CASE REPORT: A 48-year-old woman with a left ovarian abscess caused by Salmonella group 07 is reported. CONCLUSION: In our patient, the ovary may have been seeded hematogenously by salmonellae and may have evolved into a local infection. (+info)
Typhoid fever as a rare cause of hepatic, splenic, and bone marrow granulomas.
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During the course of typhoid fever, the usual histologic finding of the liver is "nonspecific reactive hepatitis." Hepatic granuloma (HG) is a rare complication of typhoid fever. We present two cases of typhoid fever with HG and review the relevant literature. Case 1 (a 53-year-old female) was found to have both hepatic and splenic granulomas. This is the first case of typhoid fever with splenic granulomas in the English language literature. Case 2 (a 66-year-old male) developed granulomas in the bone marrow in addition to HG. It should be considered that typhoid fever may lead to granulomas in several organs. (+info)
Adenosarcoma of the uterus: a case report.
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Adenosarcomas of the uterus are very rarely observed and diagnosed. In this report, we present a case of a uterine adenosarcoma that was diagnosed in February 2002. (+info)
Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: a case report.
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Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force. (+info)
Zebras on the commons: rare conditions in family practice.
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BACKGROUND: Family physicians (FPs) specialize in the management of common problems, but we know little about their role in the care of patients with rare conditions. OBJECTIVE: To describe the roles FPs play in the identification and management of patients with rare conditions in a typical practice. METHODS: Office record review of 100 patients with rare conditions in the everyday, community-based, private practice of 4 FPs. Analysis of patient demographic characteristics, diagnoses, and the roles played by the FP in the patient's care, including diagnosis, treatment, referral, and long-term patient management. RESULTS: These FPs cared for patients with a wide variety of rare disorders across the spectrum of patient age and sex, organ system involved, and medical specialty area. FPs identified the problem in 89%, diagnosed the disorder in 54%, provided acute care in 56%, and provided continuing care for 76% of patients. FPs consulted other physicians in 85% of cases. The condition was life threatening in 58% of patients. CONCLUSIONS: Family physicians provide a broad range of services to a wide variety of patients with rare medical problems. (+info)